Healthcare Provider Details

I. General information

NPI: 1205762226
Provider Name (Legal Business Name): YASEL MENDOZA PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 W TETAKUSIM RD
TUCSON AZ
85746-9713
US

IV. Provider business mailing address

6408 E STAR MICA ST
TUCSON AZ
85756-8330
US

V. Phone/Fax

Practice location:
  • Phone: 520-879-6060
  • Fax:
Mailing address:
  • Phone: 520-808-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23858
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: